Aches and Gains: A Comprehensive Guide to Overcoming Your Pain

Praise for Aches and Gains

When you’re in pain and you are desperate for an expert, Dr. Christo is just that. He’s also filled with compassion and a wonderful bedside manner. Pain is inevitable but Dr. Christo helps relieve your suffering.

—Naomi Judd, singer, author, and humanitarian

There’s no other book like it—eye-opening, motivational, and powerful. Dr. Paul Christo responds to this tremendous problem with new insights and reliable options. His care and good will for all of us in pain shines brightly, and his desire to bring forth the best and highest in everybody permeates his work.

—Clay Walker, multi-platinum country music artist

"Aches and Gains offers far-reaching therapeutic options for pain relief. Dr. Christo, and his interesting patients and prominent personalities from all walks of life, carefully guide anybody dealing with this multidimensional disease through its complexities in a remarkably understandable and compelling manner. Pain can strike us at any time in life. We are now fortunate to have a book that both serves as a beacon of hope and as a source of many evidence-based and emerging treatments that can really help."

—Rollin M. Gallagher, MD, MPH, editor-in-chief, Pain Medicine; past president, American Academy of Pain Medicine

This book is a terrific resource that everybody should pay attention to. It’s cutting-edge, easy to read, and inspirational. Dr. Paul Christo gives you the tools to move beyond your pain and into the realm of healthy living. Believe me, he is talking to YOU! I am honored to be a part of this movement!

—Gunnar Peterson, Beverly Hills–based personal trainer

Dr. Christo has created a brilliant, comprehensive guide into the world of pain packed with research-based information while also dispensing his wise, compassionate guidance. Every person will need to navigate the realm of pain in some capacity at sometime in their lives. This stellar work gives them an invaluable roadmap.

—Kathleen Hall, PhD, CEO, The Stress Institute

"If you suffer from pain, know somebody who does, or want to limit your chances of developing it, Aches and Gains is a must read. Dr. Christo covers this universal problem with great expertise and compassion."

—Coach Lou Holtz, 2008 College Football Hall of Fame Coach, retired ESPN analyst, motivational speaker, New York Times best-selling author

"Dr. Paul Christo’s insightful book Aches and Gains is a breath of fresh air, particularly at a time when we, as a nation, are experiencing an opioid-addiction catastrophe. This book offers true healing and ‘another therapeutic option’ without the dangerous effects of harsh drugs. Human beings will do anything to take away pain. It is refreshing to read a book that offers another path. If you are experiencing pain, I highly suggest you read Dr. Christo’s book before you consider any treatments."

—Suzanne Somers, actress and best-selling author

"Aches and Gains is a great resource for patients suffering with chronic pain. Dr. Christo shares his clinical and scientific expertise in a way that is engaging, informative, and empathetic, and doesn’t focus only on pills or surgery. The stories of famous individuals with pain are unique and informative, and demonstrate that pain can impact anyone. I think anyone reading this book will have a greater understanding of the causes of pain and strategies for managing it—giving them the tools to ultimately get back their lives."

—Roger Chou, MD, professor of medicine, division of General Internal Medicine and Geriatrics, Oregon Health & Science University

"Dr. Christo’s Aches and Gains provides an incredibly comprehensive overview of the many forms that pain can take, how it impacts the lives of its sufferers, and, most inspiringly, the multiple treatment options that are available for the tens of millions who suffer from chronic pain. Importantly, Dr. Christo strikes an impressive balance between conveying information that will be helpful to people experiencing pain while staying true to the current state of pain science. He artfully intertwines stories from real people with evidence-based information to both inspire and educate the reader. This book will help arm people in pain with knowledge and hope, empowering them to take control over their pain and their lives."

—Roger B. Fillingim, PhD, distinguished professor and director of the University of Florida’s Pain Research & Intervention Center of Excellence

Dr. Christo gives a truly unique and balanced overview of all potentially valid possibilities for those who suffer and have the desire to take back their function and quality of life. I would recommend this book for anyone who suffers from pain, who has loved ones in this condition, or would like to know things we can do to help this terrible problem for our society.

—Timothy R. Deer, MD, president, International Neuromodulation Society

"In the area of pain management, Dr. Paul Christo has devoted his career to helping those in need, and making a difference to improve their lives. His new book Aches and Gains is a wonderful culmination of his vast experience and knowledge. I recommend it as a helpful tool in pain management."

—Tim Janis, renowned composer

Aches and Gains

A Comprehensive Guide to Overcoming Your Pain

Paul J. Christo, MD

Boulder, Colorado

Copyright © 2017 by Bull Publishing Company

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Bull Publishing Company

P.O. Box 1377

Boulder, CO USA 80306

www.bullpub.com

Library of Congress Cataloging-in-Publication Data

Christo, Paul J.

ISBN 978-1-945188-09-1 (paperback)

Interior design and production by Dovetail Publishing Services

Cover design and production by Shannon Bodie, Bookwise Design

For those yearning to make their lives greater, richer, and healthier.

For my family—Dana, Ashton, and Francesca; and my parents.

Contents

Featured Celebrity Stories (listed in order of appearance in the book)

Foreword by Montel Williams

Preface

The Cost of Pain

The Experience of Pain

Why I Wrote this Book

Educating the Healers

Educating the Public

Acknowledgments

Introduction

Why This Book?

Organization of the Book

General Strategies for Overcoming Pain

An Important Message About Caregiving

No One is Immune to Pain, but Together We Can Overcome It

What about the Opioid Epidemic?

Part I

Understanding and Treating Your Pain

1Headache Pain

Vignette—Headache Pain: Priya

Understanding Headache Pain

Treating and Preventing Headache Pain

Hope for Headache Pain Relief

Suggested Further Reading

Other Resources to Explore

2Joint and Soft Tissue Pain

Vignette—Joint Pain: Jennifer Grey and Ty Warner

Understanding Joint Pain

Understanding Neck Pain

Treating Neck Pain

Understanding Low Back Pain

Treating Low Back Pain

Understanding Knee Pain

Treating Knee Pain

Vignette—Knee Pain: Joe Montana

Understanding Shoulder Pain

Treating Shoulder Pain

Understanding Temporomandibular Joint Disorder (TMJ)

Vignette—TMJ Pain: Yumiko

Treating Temporomandibular Joint Disorder (TMJ)

Hope for Joint and Soft Tissue Pain Relief

Suggested Further Reading

Other Resources to Explore

3Arthritis Pain

Vignette—Arthritis Pain: Kiki

Understanding Arthritis Pain

Understanding Osteoarthritis

Treating Osteoarthritis Pain

Understanding Rheumatoid Arthritis Pain

Treating Rheumatoid Arthritis

Understanding Gout

Treating Gout Pain

Hope for Arthritis Pain Relief

Suggested Further Reading

Other Resources to Explore

4Neuropathic Pain

Understanding Neuropathic Pain

Treating Neuropathic Pain

Understanding Painful Diabetic Neuropathy

Vignette—Painful Diabetic Neuropath: Jerry Mathers

Treating Painful Diabetic Neuropathy

Understanding Complex Regional Pain Syndrome

Treating Complex Regional Pain Syndrome

Understanding Trigeminal Neuralgia

Treating Trigeminal Neuralgia

Understanding Fibromyalgia

Treating Fibromyalgia Pain

Understanding Postherpetic Neuralgia (Persistent Shingles Pain)

Vignette—Postherpetic Neuralgia: Donald

Treating Postherpetic Neuralgia (Persistent Shingles Pain)

Understanding Multiple Sclerosis

Vignette—Multiple Sclerosis: Clay Walker

Treating Multiple Sclerosis Pain

Understanding Neurogenic Thoracic Outlet Syndrome

Treating Neurogenic Thoracic Outlet Syndrome

Hope for Neuropathic Pain Relief

Suggested Further Reading

Other Resources to Explore

5Pelvic and Sexual Pain

Vignette—Sexual Pain: Ellen

Understanding Pelvic and Sexual Pain

Treating Pelvic and Sexual Pain

Hope for Sexual Pain Relief

Suggested Further Reading

Other Resources to Explore

6Infant Pain

Vignette—Infant Pain

Understanding Infant Pain

Vignette—Placenta previa: Jan

Preventing and Treating Infant Pain

Hope for Infant Pain Relief

Suggested Further Reading

Other Resources to Explore

7Sports Injury and Pain

Vignette—Sports Pain: Michael McCrary

Understanding Sports Injury and Pain

Treating Sports Injury and Pain

Hope for Sports Injury and Pain Relief

Suggested Further Reading

Other Resources to Explore

8Skeletal Pain

Vignette—Skeletal Pain After Injury: Trevor

Understanding Skeletal Pain

Treating Skeletal Pain

Hope for Skeletal Pain Relief

Suggested Further Reading

Other Resources to Explore

9Workplace Injury and Pain

Vignette—Work-Related Pain: Mark Peel

Understanding Workplace Injury and Pain

Treating Carpal Tunnel and Other Work-Related Injuries and Pain

Hope for Workplace Injury and Pain Relief

Suggested Further Reading

Other Resources to Explore

10Postsurgical Pain

Understanding Postsurgical Pain

Preventing a Lifetime of Pain after Surgery: Regional Anesthesia

Vignette—Regional Anesthesia and Pain: James

Hope for Postsurgical Pain Relief

Suggested Further Reading

Other Resources to Explore

11Disease-Related Pain

Immunizations and Pain Prevention

Understanding Sickle Cell Disease

Vignette—Sickle Cell Anemia: Prodigy

Treating the Pain of Sickle Cell Disease

Understanding Lyme Disease

Diagnosing Lyme Disease

Pain and Lyme Disease

Vignette—Post-Treatment Lyme Disease Syndrome: Sarah

Causes of Post-Treatment Lyme Disease Syndrome

Preventing and Treating Post-Treatment Lyme Disease Syndrome Pain

Vignette—Post-Treatment Lyme Disease Syndrome: Ally Hilfiger

Hope for Disease-Related Pain Relief

Suggested Further Reading

Other Resources to Explore

12Cancer Pain and Caregiving

Vignette—Cancer Pain: Carla

Understanding Cancer Pain

Treating Cancer Pain

Caring for Those in Pain

Vignette—Cancer Pain and Caregiving: Lisa and Patrick Swayze

The Role of the Caregiver

Hope and Support for the Caregiver

Pain Control When Life Ends

Hope for Cancer Pain Relief

Suggested Further Reading

Other Resources to Explore

13Autoimmune Pain: A Hidden Epidemic

Vignette—Autoimmune Pain: Elvis Presley

Understanding Autoimmune Pain

Elvis Presley and Autoimmune Pain

Traumatic Brain Injury and Autoimmune Pain

President John F. Kennedy and Autoimmune Pain

Vignette—Autoimmune Pain: John F. Kennedy

Hope for Autoimmune Pain Relief

Suggested Further Reading

Other Resources to Explore

Part II

Medical Therapies for Pain: Traditional and Innovative

14Pharmacological Therapies

Acetaminophen and NSAIDs

Tricyclic Antidepressants and Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)

Anticonvulsants

Muscle Relaxants

Opioids

Medical Marijuana: Uses and Controversy

Vignette—Medical Marijuana and Pain: Montel Williams

Suggested Further Reading

Other Resources to Explore

15Pain-Relieving Devices

Vignette—Spinal Cord Stimulation: Stephen and Noah

Understanding the Nervous System and Chronic Pain

Spinal Cord Stimulation (SCS)

Deep Brain Stimulation

Vignette—Deep Brain Stimulation: Terry

Motor Cortex Stimulation

Vignette—Motor Cortex Stimulation: Lee

Vagus Nerve Stimulation

Vignette—Vagus Nerve Stimulation: Kyla

Transcutaneous Electrical Nerve Stimulation

Scrambler Therapy

Vignette—Scrambler Therapy: Colleen

Pain Pumps

Vignette—Pain Pump: Graciela

Suggested Further Reading

Other Resources to Explore

16Regenerative Biomedicine

Prolotherapy

Vignette—Prolotherapy: Trenton

Platelet Rich Plasma Therapy

Vignette—PRP Therapy: Jerome

Stem Cell Therapy

Vignette—Stem Cell Therapy: Derrick

On the Horizon: Nerve Restoration

Hope for Damaged Nerves and Pain Relief

Suggested Further Reading

Other Resources to Explore

Part III

Integrative Therapies for Pain

17Weight Control, Exercise, and Diet

Understanding Obesity, Pain, and Weight Control

Understanding Exercise and Pain

Vignette—Weight, Exercise, and Pain: Katherine

Understanding Diet, Food, and Pain

Vignette—Food and Pain: Tami

Other Sources of Information about Weight Control, Exercise, and Diet

Suggested Further Reading

Other Resources to Explore

18Sleep, Stress, and Emotional Health

Understanding Sleep and Pain

Vignette—Sleep and Pain: Fatima

Treating Sleep Problems

Understanding Stress and Pain

Understanding Emotional Health and Pain Prevention

Vignette—Emotional Health and Pain: Carrie

Hope for Emotional Pain Relief

Suggested Further Reading

Other Resources to Explore

19Mind-Body Techniques for Pain Relief

Understanding the Mind-Body Connection

Biofeedback

Vignette—Biofeedback: Clarissa

Cognitive Behavioral Therapy

Vignette—Cognitive Behavioral Therapy: Neema

Hypnosis

Vignette—Hypnosis: Marco

Other Sources of Information about Mind-Body Techniques for Pain Relief

Suggested Further Reading

Other Resources to Explore

20Alternative Medicine and Pain Relief

Holistic Medicine

Vignette—Holistic Medicine: Naomi Judd

Herbal Remedies

Acupuncture

Vignette—Acupuncture: Lila

Other Sources of Information about Alternative Medicine and Pain Relief

Suggested Further Reading

21Aromas, Music, and Pain Relief

Aromatherapy

Vignette—Aromatherapy: Amanda and Lana

Music Therapy

Vignette—Music Therapy: Tim Janis Vignette—Music Therapy: Maria and Kate

Vignette—Music Therapy: Eliana and her mother

Other Sources of Information about Aromas, Music, and Pain Relief

Suggested Further Reading

Other Resources to Explore

22Harnessing the Human Biofield

Healing with Touch and Energy

Chakra Healing

Vignette—Chakra Healing: Ruby

Healing Touch

Vignette—Healing Touch: Darla

The Japanese Healing Art of Jin Shin Jyutsu

Vignette—Jin Shin Jyutsu: Elisabetta

Distance Healing

Vignette—Distance Healing: Edina 381

Animal Therapy

Vignette—Animal Therapy: Ted

Other Sources of Information about Harnessing the Human Biofield

Suggested Further Reading

Other Resources to Explore

23Pain Relief through Movement

Yoga

Vignette—Yoga: Antonio

Pain Relief through Posture and Movement

Vignette—Feldenkrais Method: Tabitha

Vignette—Egoscue Method: Rod Susma

Vignette—Revolution in Motion: Selena

Vignette—Gokhale Method: Yeji

Other Sources of Information about Engaging the Body

Suggested Further Reading

Other Resources to Explore

24Conclusion

Don’t Wait

Reach Out for the Help You Need

Be Open

Don’t Give Up

Bibliography

Index

About the Author

Featured Celebrity Stories

(listed in order of appearance in the book)

Jennifer Grey Star of Dirty Dancing and Ferris Bueller’s Day Off. Jennifer takes us down her path of overcoming the neck pain that almost paralyzed her.

Ty Warner The creator of the Beanie Baby. Ty shares his triumphs over Tech Neck and the creation of a simple toy called the Peek-A-Boo.

Gunnar Peterson Fitness trainer to the stars. Gunnar highlights effective exercise strategies for pain relief.

Joe Montana Legendary quarterback. Joe describes how he successfully treated his arthritic knee pain.

Jerry Mathers Star of Leave It to Beaver. Jerry shares the lifestyle changes he made to combat painful diabetic neuropathy.

Clay Walker Country music star. Clay reveals his strategies for getting past the pain of multiple sclerosis.

Peggy Fleming Figure skater and Olympic gold medalist. Peggy talks about moving beyond sports pain.

Michael McCreary Former Baltimore Ravens defensive end. Michael discusses how managing pain is a team sport.

Mark Peel Executive chef and owner of Bombo. Mark shares how carpal tunnel syndrome, thoracic outlet syndrome, and low back pain have not prevented him from thriving in his career.

Prodigy Rapper and author. Prodigy describes how he overcame the pain of sickle cell anemia.

Ally Hilfiger Daughter of fashion designer, Tommy Hilfiger. Ally chronicles her unbelievable journey through a decade of pain and confusion from undiagnosed Lyme disease.

Lisa Swayze Wife of the late actor Patrick Swayze. Lisa provides a moving account of caring for Patrick during the last 22 months of his life with pancreatic cancer.

Foreword

Four months before I graduated from the United States Naval Academy, I suffered my first bout of multiple sclerosis (MS), losing 80% vision in my left eye. One of the many topics that Dr. Christo’s book covers so well is that feeling of embarrassment when pain creeps into your life. I was 22 years old at the time, in the best shape of my life, lifting weights and looking good. I didn’t want to admit to anyone—including myself—that something was wrong with me.

If I’d caught the problem back then, maybe I could have nipped it in the bud, or at least started on a treatment regimen to mitigate its symptoms. Instead, I let it fester. It wasn’t until 1999, after I felt a sharp and chronic pain in my feet, that I finally took action, consulting with various doctors, one of whom delivered the shocking news: He said that I had MS I’d be in a wheelchair in four years, and dead by age 57.

Another feeling that Dr. Christo writes about so eloquently is the feeling of hopelessness that goes hand in hand with chronic pain. Lying awake every night in tears from the pain, as I counted down to 57, wondering if I should expedite the inevitable—it felt like that moment when you get to the top of a hill, look up, and see this impossible mountain. I realized I had a choice to make: I could spend the rest of my life feeling sorry for myself, or I could look at my illness as a call to action and start climbing.

Dr. Christo outlines all the tools you need for the climb, beginning with seeking help from loved ones. The emotional distress and helplessness that often accompany pain, he writes, can be just as destructive as the physical aspects of the pain.

He also writes about taking your health into your own hands, which, for me, has been essential. After my diagnosis, I made dramatic changes to my diet and exercise routine. I poured myself into an intense treatment regimen and sought out experimental therapies. I appreciate Dr. Christo’s thoroughly researched section on cannabis, including various ingestion methods, its complex structure, and its therapeutic effects. After doctors prescribed opioids for my pain, triggering a severe addiction and irreversible damage to my body, I was told to try cannabis as part of my treatment. For me, cannabis has been more than a treatment for the pain. It’s become a lifesaver.

Finally, as Dr. Christo advises, you can never lose hope. That’s easier said than done, especially when the pain keeps coming back, again and again; but it’s necessary. Personally, I found hope—and purpose—in sharing my experience with others by writing books, promoting healthy living, and starting an MS Foundation. Helping others, I’ve found, gets me out of my head and gives me a reason to wake up in the morning, to keep battling the pain, and to continue climbing that mountain.

Montel Williams

Preface

The Cost of Pain

Throughout the world, pain is poorly controlled—80% of the world population has little or no access to treatment for moderate or severe pain. In fact, the World Health Organization estimates that pain threatens to condemn one out of every 10 people alive today to die a painful death. It’s that serious. Pain touches all of us during our lives and has become a pressing humanitarian crisis.

Chronic pain affects 116 million U.S. adults, and 40% of people living in developing countries. It doesn’t spare the more vulnerable members of society, affecting 20% of all children and increasing in prevalence in senior adults. Chronic pain is growing in magnitude as well. Those surviving HIV, cancer, and cardiovascular disease are now able to live longer lives, but find themselves living a poorer quality of life due to continual pain from their disease or from interventions needed to treat the disease, such as chemotherapy, radiation therapy, or surgery.

Sadly, not everybody makes it. Compared to those without chronic pain, people living in pain are twice as likely to commit suicide. Pain not only takes lives and debilitates individuals and families, but it costs the U.S. economy more than half a trillion dollars annually. And despite these alarming facts, research funding is lower for the study of pain in the United States than it is for any other chronic health problem. The quest for relief continues, however.

Pain relief is a multi-billion dollar industry. Each year, millions of Americans empty their wallets for pain medications, surgery, and various other therapies in a desperate attempt to alleviate their symptoms. Many turn to alternative medicine—from acupuncture and yoga to dietary supplements and aromatherapy. Still others use illegal substances or become entangled in other addictive behaviors, searching in vain for relief from suffering they do not understand. Sometimes the quest to ease pain can become more frustrating than the pain itself.

But it doesn’t have to be this way. Recent advancements in both medicine and technology have revolutionized the way we understand and treat pain. Pain may be part of life, but chronic pain and the frustration it brings with it do not have to be part of your daily experience.

The Experience of Pain

An individual’s experience with pain is as unique as his or her fingerprints. As a pain medicine specialist at the Johns Hopkins Hospital in Baltimore, Maryland, I have seen firsthand that pain can manifest so differently—sharp or dull, severe or muted, pounding or burning. It can occur intermittently or all the time, touching one part of the body or every part. None of us experience pain in quite the same way, but no matter who you are, when you experience pain, it is almost always impossible to ignore.

Pain is supposed to get our attention and often serves a vital function in our survival. After all, if the nerves in your fingers didn’t immediately alert you that the stove was hot, you could get some serious burns before you pulled your hand away. The memory of the pain also reminds you not to get too close next time. Pain plays a role in helping us assess illness as well as injury. That sharp pain in your chest tells you that your cold has progressed to the point where you need to see your doctor.

But pain can take on a life of its own. Think of a home security system: The alarm goes off to alert you that your home and possessions may be in danger. But what would happen if the alarm malfunctioned and couldn’t be disarmed? Its constant blaring could make your home uninhabitable. Chronic pain behaves the same way—a siren that persists long past the point of doing any good, interfering with every aspect of life. It becomes a disease itself, rather than just a symptom of another condition.

Chronic pain is a special kind of pain. It is a complex process of changes in and reorganization of the central nervous system (brain and spinal cord). It’s typically defined as pain lasting for three months or more. We’re realizing that the environment, genes, and imbalances in neurotransmitters can all contribute to the origin of chronic pain. In some ways, chronic pain is like Parkinson’s disease or Alzheimer’s disease. The progression of all of these disorders leads to substantial changes to nerves in the brain and spinal cord. Chronic pain is unlike these conditions as well though; we’re learning that we may be able to restore normal or near normal nerve function once chronic pain has developed by implementing effective treatments.

As the pain-relief industry has grown, it has become more and more challenging to distinguish the real solutions from the snake oil. Some experts market potions and techniques that have absolutely no science behind them. And at the same time, far too many authentic medical doctors are completely unaware of the wide range of tools and techniques scientifically proven to help patients combat and defeat pain. I know, because I was one of those doctors: I knew everything medical school taught me about how to treat my patients, but I knew very little about how to help them with their pain.

Why I Wrote This Book

Although I knew I wanted to go into medicine from a young age, my journey took some interesting detours along the way. I grew up in Moraga, California, a suburb of San Francisco. Soon after entering high school, I organized a squad of Boy Scouts to feed the hungry at a soup kitchen in Oakland. Organizing this event was the last step in meeting all of the requirements for the rank of Eagle Scout. I felt confident in my ability to pull it off until I learned that the shelter was expecting 300 people that day!

With a lot of organizing and delegating, I was able to purchase, prepare, and distribute food to all of those people and earn the rank of Eagle Scout. It was a tremendously moving experience for many reasons, but my heart was particularly affected by meeting the many homeless people who walked with a limp or had visible wounds on their bodies. Some had dried blood on their faces or limbs. Others winced as they sat down. Most were middle-aged and alone, but some brought their family members—young children or parents—all of whom suffered from the pain of hunger. This was more than a day of service for me. It was a window into a world of suffering that I never knew existed.

I often wonder whether that one day as a young Scout led me to choose a life of easing pain—pain resulting from visible wounds as well as unseen sources. During the promotion ceremony, my scoutmaster said something that has stuck with me since, Scouting is far more than fun in the outdoors. Scouting is a way of life. Scouting is growing into responsible manhood, learning to be of service to others. My scoutmaster modeled this service as a leader and a professional. He was a cardiologist and the example he set strengthened my own personal desire to become a physician. I wanted to continue serving others, but I wanted to be able to offer those in need more than just a ladle of soup.

My college years gave me the chance to volunteer on the suicide prevention hotline for the city of South Bend, Indiana, and later serve as a summer intern-scholar on two adolescent mental health units in Green Bay, Wisconsin. Though I had set my sights on medical school, I elected to spend one year working as a chemist for a medical diagnostics company called Microgenics Corporation. The company was filled with ambitious college graduates eagerly pursuing careers in science. This time greatly enhanced my teamwork, negotiation, and organizational skills, which have served me very well as a doctor and especially as a pain specialist.

Medical school offered me the opportunity to work as a research fellow at the National Institutes of Health (NIH) in Washington, D. C. While working in the Clinical Brain Disorders Branch, I helped develop a novel approach for analyzing the magnetic resonance imaging (MRI) brain images of schizophrenic twins. I was poised to become a neuropsychiatrist, like my mentor at the NIH. But like all medical students, I was required to rotate through various medical specialties, and my time with anesthesiologists during my fourth year of medical school changed the course of my career forever.

I was intrigued with the procedures I saw used in the operating room, such as nerve blocks, spinals, epidurals, applied physiology and pharmacology. I was amazed by the powerful pain-relieving effects of morphine given to patients intravenously during surgery. I could watch patients’ heart rates and blood pressure drop and their breathing become slower and deeper as they drifted peacefully into a state of calm. By the end of my rotation in the operating room, my focus had shifted to anesthesiology and analgesia.

My interest in pain medicine intensified during my internship. I treated many patients in the clinic for chronic obstructive pulmonary disease (COPD), pneumonia, and hypertension with reasonable success. However, I often felt helpless when treating patients suffering from chronic back pain, arthritic pain, or neuropathic pain. Few of the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) or naproxen (Aleve), that I recommended during this period were able to bring true relief to these painful conditions. I knew opioids would alleviate the pain more effectively, but I never felt comfortable prescribing them, even short-acting ones such as oxycodone (Percocet) or hydrocodone (Vicodin). Like doctors today, many physicians back then wanted to avoid opioids but really didn’t know what else to use when the usual drugs failed.

As a physician, nothing is more frustrating than watching your patients suffer and feeling like you can’t do anything about it. As I gained more clinical experience, some patients would tell me how opioids were life-saving, while others wanted nothing to do with them and feared addiction. Pain was everywhere and on everyone’s mind. Yet, as a new doctor, I received no formal education on pain care. Furthermore, I had no knowledge of pain-relieving injection treatments, implantable devices, neuropathic medications, cognitive behavioral therapies, or the physical restoration methods that can be so critical to alleviating chronic pain.

In short, even after I became a doctor, I felt ill-prepared to care for people in pain. Unfortunately, I have found that this is the norm and not the exception among healthcare professionals. Very few doctors understand the basics of pain diagnosis and treatment any better than I did as an intern. This lack of knowledge and experience on the part of physicians results in unnecessary and prolonged suffering for many patients.

Today, I treat patients who are experiencing all kinds of pain, and I educate healthcare professionals and pain sufferers all over the country about the vast array of methods available for pain control. While raising awareness about the under-treatment of pain, I have had the opportunity to lead many educational programs during regional and national pain conferences, to speak at national and international medical meetings, and to be a an investigator in research projects published in peer-reviewed journals. I’ve also served on advisory committees for national pain organizations; chaired annual pain medicine conferences for pain specialists and primary care physicians; consulted for the development and expansion of a pain center in the Middle East; and mentored students interested in pain medicine and research. I’ve even served as the pain expert for the Web Chat Series on Pain Management for the Tribune newspapers and made guest appearances on various radio and television programs. In short, I’ve not only been able to help my own patients conquer their pain, I’ve been able to reach out to other healthcare professionals and the general public.

Educating the Healers

My life’s work is focused on improving the lives of people in pain through clinical care, education, and clinical investigation. The education component is multifaceted, and it begins with the physician population. Despite considerable gains in diagnostic and therapeutic approaches to pain, for many people, that chronic pain alarm system just keeps blaring day and night. Until our doctors are better educated about these new advancements, countless patients will continue to suffer from treatable pain across the country and throughout the world. We always need to do more research, but we also need to make sure that clinicians can easily access the results of the research we’ve already conducted. We must continually improve clinicians’ overall knowledge of pain diagnosis and treatment to alleviate unnecessary suffering. A critical step toward this goal is empowering physicians to partner with patients along the way, to listen to them and advocate for them.

Although there is still tremendous work to do, I have seen many encouraging developments over the past several years. My position as a speaker and educator has enabled me to train physicians from a variety of medical backgrounds—such as physiatry (rehabilitation physicians), anesthesiology, neurology and rheumatology—in state-of-the-art and evidence-based diagnostic and therapeutic approaches to managing pain. Many of my trainees have expanded pain programs in other academic settings or private practice settings, and some have even created new pain centers.

Medical residents who rotate through our pain treatment center are empowered to make informed decisions for pain patients in the operating room, hospital setting, or in outpatient clinics. As greater numbers of trainees complete our program, more physicians will have the skills to improve treatment for patients with pain and serve as compassionate advocates for pain education.

Educating the Public

As gratifying as it is to educate fellow doctors and healthcare workers in cutting-edge pain management techniques, I have also learned that there is a tremendous need to educate the public. Patients who learn about the options available to them can work much more effectively with their healthcare providers to control and eliminate pain. Both policymakers and the public need to be aware that chronic pain is a legitimate medical condition. The recognition of this fact fosters greater access to pain care, reduces the stigma associated with chronic pain, and promotes effective research. When pain is treated as a legitimate concern, chronic pain patients are better able to become active participants in their own care, chronicle the effects of pain-relieving medications and procedures, and participate in multidisciplinary treatment options such as mind-body therapies and various methods of physical restoration.

The more I began to share information about pain relief and management with general audiences, the more I learned how crucial it is to dispel some extremely popular myths surrounding pain and its treatment. These include:

◆Myth: Pain is not a valid medical condition.

◆Myth: Pain medications like morphine always lead to addiction.

◆Myth: Pain builds character and is simply a part of life.

◆Myth: Healthcare professionals can easily identify and quantify a patient’s pain experience.

In addition to multiple media and public speaking appearances, I began a weekly radio talk show in 2011 that is now nationally syndicated on Sirius XM Radio. The program, called Aches and Gains, highlights compelling stories of people who have found relief, shares information about cutting-edge treatments from contributing experts, and suggests ways that people in pain can improve their daily lives. Several celebrities with pain, including Joe Montana, Naomi Judd, Montel Williams, the late Maya Angelou, and Jennifer Grey, have brought their own stories of success to the show. Their stories make us realize that nobody is immune to pain, but together we can overcome it.

I wrote this book as an extension of my work to ensure that everyone has an opportunity to learn about the newest and best methods for diagnosing and relieving pain. My goal is to make all the relevant medical information comprehensible for the general public so that you can understand what is going on in your body and what to do about it.

If you or a loved one suffers from poorly controlled pain, this book is about learning to live either pain free or with effective, practical pain management. This book is for anyone who currently suffers from pain and it is also for anyone who is concerned about developing pain in the future. Since pain can strike us at any stage of life, I cover ways to treat pain from infancy to old age.

While no book can properly diagnose your condition or replace your primary care doctor or local pain specialist, I have done my best to address the pain you’re feeling, explain it, and offer possibilities for relief, so that you can live the life you were meant to live.

Acknowledgments

I’d like to acknowledge the perpetual encouragement of my friend and mentor, Mark Hubbard. As an entrepreneur and media-savvy individual, Mark has listened, provided guidance, and then shared his connections. He has been an invaluable resource for creating the radio show from which this book was conceived. It is also important to thank my many radio show guests who have shared their stories of overcoming hardships so that others may benefit. I’m also appreciative of the creative force of Ty Ford, friend and producer. Special thanks to my editor, Erin Mulligan for her critical review and suggestions on the manuscript. I wish to extend my appreciation to my colleagues, past and present at the Johns Hopkins Blaustein Pain Treatment Center for their training and collegiality. Finally, I’m indebted to my wife, Dana for her generosity and self-sacrifice. She made this book possible.

Introduction

Why This Book?

This book is designed to provide a down-to-earth understanding of painful conditions that many of us will experience in life. It can serve as your guide to learning about your pain, how to prevent your pain from continuing, and what to do if your pain becomes chronic. It provides options for supporting a loved one in pain and how to cope if you have pain yourself.

I’ve distilled important evidence from research findings, added recommendations from my expertise as a pain specialist, and combined these with insightful suggestions from contributing experts and success stories from guests on my radio show, Aches and Gains. These guests include celebrities, well-respected experts, and everyday people—all have valid experiences and make worthwhile suggestions about overcoming pain.

A special feature of this book includes links to specific radio shows that correspond to the topics covered in each chapter. Listening to the shows will supplement your understanding and expand your learning about a particular condition. They all aired live on Sirius XM Radio and were subsequently made into podcasts. Each show is easily downloaded to your smartphone or computer.

Interspersed throughout the book are real stories of celebrity guests from my radio show who have overcome their pain: sports figures such as Joe Montana; actors such as Jennifer Grey and Jerry Mathers, The Beaver; music stars such as Naomi Judd, Clay Walker, and Prodigy; Ally Hilfiger, producer, artist, and daughter of fashion designer Tommy Hilfiger; executive chef Mark Peel; composer Tim Janis; talk show host Montel Williams; and Lisa Swayze, wife of the late actor Patrick Swayze. There are also revealing accounts of Elvis Presley and President John F. Kennedy. Each of their stories reminds us that pain touches everybody, and like them, we can overcome pain too.

Organization of the Book

The book is organized into three parts. The first part, Understanding and Treating Your Pain, delves into common pain conditions and how best to treat them. The second part, Medical Therapies for Pain: Traditional and Innovative, concentrates on conventional as well as less known medications used to ease pain and then launches into the exciting world of pain-relieving devices and the brave new world of regenerative therapies such as stem cells. Finally, the third part, Integrative Therapies for Pain, examines the benefits of modifying everyday activities such as diet and sleep in order to control pain, and also introduces the reader to the realm of mind-body and spiritual practices, which can be surprisingly effective as pain managing strategies.

General Strategies for Overcoming Pain

Many patients want a road map for overcoming pain. There is no single path, but there are some steps and strategies that can help you get your life back from chronic pain.

◆Step 1: A good practical first step in gaining control of any type of pain is keeping a pain journal. In this journal, note the triggers, the quality of the pain, the pain’s duration, and any associated physiological responses, such as sweating or memory problems. Keep note of how your mood changes and whether you find yourself missing out on activities. Also keep track of anything that makes the pain better.

◆Step 2: Bring your pain journal to your doctor or healthcare professional. Share how your pain began and how it has influenced your life, and mention all previous treatments whether they have helped or not.

◆Step 3: While you work with your healthcare team to address your pain, make sure you are also doing all you can at home to stay as healthy as possible. This step involves implementing the everyday suggestions from this book about eating healthy, anti-inflammatory foods, exercising, managing your stress, and optimizing your sleep. Most doctors don’t discuss the value of these strategies in appointments, so I have described them in the book for you to incorporate yourself. Even if they reduce your pain by just 25%, they are moving you closer to your goal of feeling more in charge of your life and making a healthy change.

◆Step 4: Possess the personal force and belief that you can improve. This will advance your upward progress. I have seen optimistic patients gain from cultivating a positive attitude when others without it out lag behind. See yourself feeling better and doing things you want to do. Have this image in your mind continually. This stabilizes your path to wellness. Without a positive attitude, the disappointments tend to crush your spirit. It’s like a badly built house with walls that are not strong enough to sustain the roof. If the walls are unstable, the roof crumbles down and the house falls into ruins. Strengthen the walls with a never-ending belief in creating a new self, of being more than you are now.

◆Step 5: Ask for help and be open to treatments. Don’t eliminate recommendations based on what you have heard from friends or the Internet. Inform yourself of the facts and don’t stop learning about your condition and your pain until you find the relief you need. Relief may come from cutting-edge treatments or holistic methods of pain relief. Or a combination of techniques may achieve the most striking result. If you are not looking, you won’t find help or relief.

An Important Message about Caregiving

Take care of yourself if you are taking care of someone else in pain. Many people care for a family member or friend in chronic pain. They take them to medical appointments, help them get dressed and bathe, prepare meals, clean the house, and maintain a job. Dealing with anger, depression and suicidal thoughts, anxiety, and withdrawal from life on the part of the patient in pain is taxing for any caregiver. The entire process exacts a substantial emotional and physical toll. Make sure you carve out time for yourself by taking breaks, participating in support groups, or getting somebody else to step in from time to time.

No One Is Immune to Pain, but Together We Can Overcome It

Pain can strike at any time, from infancy to older age. Chronic pain can gradually chip away at our capacity to enjoy even the most basic pleasures in life and dissolve our ability to accomplish our dreams. The key to overcoming pain rests in taking ownership of your own health, not giving up, and reaching out to experts for guidance. I hope this book will draw back some of the many veils that can cover new opportunities for feeling better, opportunities that will make a difference in your life and allow you to see what is possible.

What about the Opioid Epidemic?

No doubt you are familiar with the opioid epidemic. This phrase is prevalent in all forms of media—print, radio, television. There is definite cause for concern over the non-medical use of opioids and the 2016 Centers for Disease Control and Prevention (CDC) guideline is curbing opioid prescriptions to help control the problem. There are countering opinions on the value of this strategy and its impact on legitimate chronic non-cancer pain patients using opioids for relief. In my experience, most patients on chronic opioid therapy take their medications responsibly. The non-medical use and abuse occurs more often in those obtaining opioids from family members and friends or by other means. That is not to say that patients using opioids are immune to risk. On the contrary, they require close monitoring, education, and discontinuation if they lose control over opioid use or don’t improve their function or quality of life. Only a minority of patients should be considered for opioid therapy after careful assessment of risks, benefits, and medical necessity. As you will see from reading this book, there are an array of non-opioid pain-relieving options for patients—and that is good news. Pain specialists are able to offer many of these strategies and alternative practitioners provide access to the others. This book is full of information about these options. My hope is that you will read it and explore these options and find something that works for you.

PART

I

Understanding and Treating Your Pain

CHAPTER

1

Headache Pain

When Priya first walked into my office, she had come to the end of her rope. A young mother of two who had once led an extremely active life, she had been battling debilitating migraines since becoming pregnant with her first child. The pain would appear without warning, beginning in her eyes and the back of her neck. It moved up through the base of her skull, blurring her vision and causing her eyes to water. Finally, her entire head would be so crushed with pressure and pain that over-thecounter medications, such as aspirin or acetaminophen (Tylenol), did nothing.

Headaches are not unusual. It’s estimated that 46% of adults across the world have an active headache disorder. But the pain Priya experienced went far beyond the typical tension headache. It caused nausea and vomiting, condemning her to lie in bed in a dark room for days at a time. Her husband would beg the children to stay quiet so Mommy could rest. In addition to interfering with their daily routine, the family found themselves canceling vacations and social engagements when Priya’s migraines mercilessly incapacitated her for days.

Priya’s doctors prescribed increasingly strong prescription pain pills, suppositories, and patches to try to manage these episodes. And while the medications enabled her to sleep off the migraine if she caught it early enough, they did little to nothing if she didn’t catch it in time. Her days were haunted by the anxiety that a headache could appear at any time. Finally, her doctors resorted to injectable opioid painkillers and, in time, sent her to me.

The key to Priya’s long-term relief came from an unlikely ally: Botox injections. Known primarily for its cosmetic abilities to minimize wrinkles, botulinum toxin (Botox) is actually a neurotoxin produced by the same bacteria that causes serious food poisoning. In small doses, Botox blocks the signals sent from nerves to muscles, preventing the muscles from contracting. New research now suggests that Botox may also reduce pain and inflammation by inhibiting neurotransmitters, which are the chemical messengers that transmit pain signals and sensitize the spinal cord to pain. Its utility for treating migraines was discovered when a number of the patients who were getting cosmetic treatments reported experiencing migraine relief as well.

I treated Priya by inserting a tiny needle into the muscles of her forehead, scalp, and along the back and sides of her head. I also gave her injections in the back of her neck and even above her shoulder blades. Research supports the efficacy of precise needle insertion sites, which target the muscles and trigger zones that are the sources of pain. Unlike muscle relaxants or injectable pain relievers, which focus on relieving pain after a headache has begun, Botox injections are used to prevent headaches. After regular treatment, Priya’s headaches became less frequent and less intense. Although not yet medication free, Priya has regained a significant level of control over her migraines and, as a result, is living a richer, fuller life.

Understanding Headache Pain

Headaches can range from garden-variety tension type headaches to full-blown migraines. As I noted in Priya’s story, an estimated 46% of adults across the world have an active headache disorder, and 99% of women and 93% of men experience headache pain in their lives.

Causes of Tension Type Headache (TTH) Pain

Everyday headaches known as tension type headaches (TTH) can be triggered by any number of common causes including, allergies, stress, fatigue, injury, illness, sun exposure, dehydration, or caffeine withdrawal, to name just a few. The pain from TTH is typically mild-to-moderate in intensity, on both sides of the head, and doesn’t throb. Patients of mine who are experiencing TTH will say that they feel like a tight cap is on their heads or a tight band constricts their heads. Some even have nausea. Diagnostic testing (magnetic resonance imaging (MRI) or computed tomography (CT scan) is usually not needed for TTH.

Physicians currently believe that sensitization of pain receptors in the muscle or fascia around the head lead to these types of headaches. Pain receptors around blood vessels and tendons may also be sources of pain. If these pain receptors continue to send signals to the central nervous system, then chronic TTH develops. Similar to brain imaging studies in patients with chronic low back pain, one study in patients with chronic TTH showed a decrease in a certain type of brain tissue called gray matter in those areas of the brain involved with pain processing. This highlights the importance of treating TTH so that it doesn’t become chronic.

Tension type headaches are often the normal reactions of the body to problems that the pain should prompt us to correct. A dehydration headache reminds you to drink more water. A person suffering from a cold or the flu will hopefully be driven by a mild headache to get much needed rest. Often, mild headaches can be remedied or prevented by getting adequate rest, drinking more liquids, and taking steps to reduce stress, tension, and anxiety in your life.

Causes of Migraine Headache Pain

Unlike everyday tension headaches, migraine and cluster headaches arise from spontaneous pain signals that serve no health-related purpose. People who suffer from these types of headaches on a regular basis are often born with sensitivity to certain stimuli. When present, those stimuli, such as light, sound, certain foods or food additives, can spark unbearable, throbbing, and usually one-sided pain.

Twelve percent of the U.S. population suffers from migraine headaches. An attack usually unfolds gradually over the course of hours to days, and most migraine sufferers (including myself) don’t experience an aura, a strange sensation such as dizziness, ear-ringing, or flashes of light experienced before the headache. If left untreated, an attack will continue for several hours or even days. I suffer from episodic migraine headaches, which happen occasionally, whereas others experience chronic migraines, attacks occurring 15 days or more monthly for at least three months with headaches lasting four hours or more.

Migraines appear to be connected to hormones, since three times as many women experience them as men, most often during their childbearing years. Fortunately, women suffer less frequently after menopause, and migraines are relatively uncommon in children. We also believe that there is a genetic basis to migraines, but gene studies have not yet clarified which ones are actually linked to the disorder.

Migraine headaches begin at the headache center of the brain, a small area in the brainstem. This bundle of nerves is like a busy central traffic intersection between the brain and the body; nearly every neural signal from the